OPHTE#_ Q°1-5--JZ~-g bQ Harnett County Department of Public Health 21 3 2 9
PERMIT # =15(r, Operation Permit
New Installation 'R Septic Tank ❑ Repair. Nitrification Line ❑ Expansion
PROPERTY LOCATION: V3,j t y ez>
Name: (owner) ~o.v l rs is ~v~ SUBDIVISION 'E a [s~ O~ cs PH LOT # V~5
System Installer: O . G. G~ Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms H
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 1,00 feet
System Type: =1 5 Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
ma srslem nas oeen mstaueo in compoance wim appucame norm carmma oeneral )tatutes, Rules for sewage treatment and Disposal, and all conditions of the Improvement Permit and construction Authorization.
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1. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ N
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
Following are the specifications for the sewage disposal system on the above captio~property.
Type of system: ❑ Conventional 1 Other Ci Picnea)- wtv.~~ `i 1 Septic Tank: 10156 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 1" 0 feet ditches 3 feet ditches inches
French Drain Required: Linear feet
Authorized State Agent CF-~N-\ Date 3 11 10
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